Nephritic Syndrome Flashcards
What is nephritic syndrome
Syndrome fitting the clinical picture of inflammation within the kidney
Defining features of nephritic syndrome
Haeamaturia - reflects inflammation of the kidney
Oliguria - due to reduced GFR
Proteinuria - less than 3g/ 24hrs
Hypertension - due to fluid overload
Systemic causes of nephritic syndrome
SLE
Post strep GN
Iga nephropathy
good pastures
GS diagnostic test for nephritic syndrome?
kidney biopsy
Other investigations for nephritic syndrome
Urinalysis - shows haematuria in nephritic syndrome
Bloods- elevated ESR and CRP in inflammation ; may be anaemia
What is an ESR test and what does it do
Erythrocyte sedimentantion rate
Test measure how fast/ slow RBC will sink / settle
Inflammation causes RBC to clump together which are heavier to sink faster
What does a CRP test do and show
C reactive protein is made in the liver
more is released in response to inflammation
can only diagnose inflammation not the cause of it
Management of nephritic syndrome
Blood pressure control- ACE/ ARB, reduces proteinuria and preserves renal function
Corticosteroids- reduce inflammation causing damage to the kidney
What is Iga nephropathy
Defined by the presence of mesangial Iga immune deposits
Explain the pathophysiology of Iga nepropathy
immune complexes are formed –
become trapped in glomeruli– deposit in mesangial area which normally offers structural support to glomeruli
Key diagnostic factor of Iga nephropathy
Haematuria - blood in urine
How are ace inhibitors effective in iga nephropathy
- decrease the pressure of blood entering kidneys
- decrease inflammatory damage
- slow progression of the disease
What would immunofluorescence microscopy show for iga neprhopathy
Iga complex deposition
What is post streptococcal glomerulonephritis
Where the kidneys glomeruli become inflamed after an infection by streptococcal bacteria
When would PSGN usually present
1-2 weeks after pharyngitis from group a b haemolytic strep
Diagnosis of PSGN would show ?
Light microscope- hypercellular glomeruli
Immunofluorescence shows - starry sky appearance and igg and igm deposits
electron microscope- subendothelial immune complex deposition
treatment for PSGN
- Furosemide: for initial treatment of hypertension
- Antibiotics
Pathophsyiology for PSGN
- Group a streptococci carry M protein virulence factor which initiates a type 3 hypersensitivity reaction
- the immune complex depositions travel to the glomerular basement membrane and deposit
- the deposit initiates an inflammatory reaction which invovles activation of C3 complement,
clinical manifestations for psgn
Haematuria
signs of recent infection
What occurs in good pastures syndrome
ANTI GBM antibodies attack the glomerulus and pulmonary basement membrane
This causes glomerulonephritis and pulmonary haemorrhage
Typical presentation of good pastures syndrome
acute kidney failure and haemoptysis (coughing of blood)
What is the most common cause of primary glomerulonephritis
iga nephropathy
What is the most common type of glomerulonephritis overall
membranous glomerunephritis
Key causes for both nephrotic and nephritic syndrome
diffuse proliferative GN
membranoproliferative GN
What is IgA nephropathy?
Deposition of IgA into mesangium of kidney - causes inflammation and damage
Presents asymptomatically with microscopic haematuria
Diagnose by biopsy
Give fish oil and steroids for persisten proteinuria after 3-6 months
What is goodpastures disease
Goodpasture syndrome is an autoimmune disease that primarily affects the lungs and the kidneys.
Also known as anti-GBM disease and is a rare small-vessel vasculitis.
What is post strep glomerulonephritis (cause of glomerulonephritis)
Deposition of strep antigens post infection
Presents with haematuria and acute nephritis
Diagnose with eviden of strep infection
Antibiotics and supportive care
Henoch choenlein purpura (Cause of glomerulonephritis)
Small vessel vasculitis
Affects kidneys and joints due to IgA deposition
Triad of symptoms for nephrotic syndrome
Hypoalbuniaemia (loss of albumin in urine)
Proteinuria (>3g/24hr)
Oedema - loss of albumin therefore loss of oncotic pressure
Causes of nephrotic syndrome
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy c
